Athletic Hip

Hip problems in athletes present in ways that are different from how they present in the general population. A small number of athletes present with hip pain following an injury. The most significant one is a dislocation of the hip. This usually occurs with the hip in flexion: with a severe blow to the knee, the hip can dislocate posteriorly. The hip will have to be relocated under sedation or a general anesthetic in the hospital. We usually find a ligamentum teres, labral tear and or articular cartilage lesion following this injury. Another example is a fall on the trochanter (thigh bone) resulting in an articular cartilage lesion or ligamentum teres injury.

The majority of athletes who present with hip pain have femoroacetabular impingement. The presentation can be subtler than in the general population where very often daily life activities are affected. In the majority of athletes, the main symptom is problems with running fast and pivoting on the affected hip. Often athletes have been suffering from recurrent Hamstring problems before the attention has been shifted to the hip joint. Activities such as striking the ball are usually not affected. Athletes with impingement very often have a noticeable reduction in range of motion of the hip compared with their non-affected peers.

Although pain is usually the main factor for an athlete to have surgery, sometimes the functional problem can be so significant that, although the patient is pain free, surgery is nevertheless required. In golf the restriction of internal rotation of the stance leg can reduce the golfer’s driving distance whilst performing his tee shot. We can see golfers’ tee shots improving significantly following a cam resection and treatment of femoroacetabular impingement. Impingement does not always occur in patients with a bony abnormality of the acetabulum or femoral neck, but can occur in sports that require a range of motion above the normal range. Examples of these activities are dance and dressage. Not only the activity, but also the type of surface can be responsible for hip pain and we see a higher incidence of hip and groin problems in sports were athletes train and play on astra turf; the most common examples are football and hockey.

In sports that require a lot of rotation of the hip, such as golf, tennis, football and javelin, strain of the anterior capsule of the hip can occur. The athlete can start to complain about instability due to stretching out of the iliofemoral ligament. As a result of the increased laxity of the hip joint, tears of the labrum can occur, at which stage pain during sports activities commences.